NSG 3320: Nursing and Mental Health
Nursing Munchausen Syndrome by Proxy
March 21, 2005
Nursing Munchausen Syndrome by Proxy
Imagine meeting a young family wherein the child has suffered from many painful medical treatments and procedures as a result of many illnesses. The mother is intelligent, attentive and always involved in the care of her child. This child is a survivor, beating the odds and goeing through painful procedures, testing and surviving multiple surgeries. Appropriately your heart goes out to this family. You hope for the best and as a nurse provide professional care for the child and family. The mother is always helpful and attentive with the care of her child. You develop a therapeutic relationship with her. Now how would you feel if you were discovering that this mother was inducing the ailments onto her child? This child is perfectly healthy. But has undergone multiple procedures and surgeries because of induced or feigned symptoms. Unfortunately this is a profile that has been proven to be reality. This is an illustration of Munchausen Syndrome by Proxy.
There have been highly publicized cases of MSBP. “Hillary Rodham Clinton chose Jennifer Bush to represent her campaign for health care reform” (Dowdell & Foster, 2005). Afterwards Jennifer’s mother was charged with inducing medical problems on her that could not otherwise be explained. As a result of her mothers actions Jennifer was subjected to more than 200 hospitalisations and 40 surgeries (Dowdell & Foster, 2005). MSBP is now recognised to be “an unusual and potentially lethal form of child abuse” (Dowel & Foster, 2005). The victim is the child. In Jennifer’s case she suffered physical consequences needlessly and now lives without her gallbladder, appendix and part of her intestines as they were surgically removed.
First identified in 1951, Munchausen syndrome was named for Baron van Munchausen, an eighteenth century German aristocrat infamous for his tall tails (Smith-Alnimer & Papas-Kavalis, 2003). The syndrome was named for its characteristic lies. Individuals with Munchausen syndrome induce or invent elaborate and contradictory symptoms and demand medical treatment for themselves (Yonge & Haas, 2004). Closely related is Munchausen syndrome by Proxy (MSBP). Roy Meadow first described MSBP in 1977 (Schreier, 2002). MSBP is catalogued in the American Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a fictitious disorder. However MSBP “has yet to be recognized as an official separate category in the DSM-IV” (eMedicine, 2002). It is recognised in section 300.19; Factitious Disorder not otherwise specified.
There are four specific criteria for the diagnosis of MSBP. MSBP involves the fabrication or induction of an illness in one person by another (US National Library of Medicine, 2004). The motivation for the behaviour is to assume the sick role by proxy. All external incentives, such as economic gain are absent and the behaviour is not otherwise accounted for by another mental disorder (eMedicine, 2002). As with most mental disorders the pathophysiology is unclear. There is no test that indicates a positive diagnosis of MSBP; a diagnosis is reliant on many accumulated factors or evidence.
Individuals diagnosed with MSBP are found in all socio-economic classes and ninety five percent of the time the mother is the perpetrator. The majority of the families with an MSBP diagnosis are dysfunctional but have a tendency to be intact. A family history of Munchausen syndrome or MSBP is also a risk factor of MSBP (Dowel & Foster, 2005). The perpetrator may have Munchausen Syndrome herself and have a complicated health history. Cases usually start in infancy and up to six years of age. If it continues as the child ages, the child may accommodate to the deceptions. Older children are more likely to reveal the truth about their symptoms as they are out of the home for school (Dowel & Foster, 2005). Considering all of these characteristics the nurse caring for a child suspected of being affected by MSBP should be mindful of such signs and document any findings objectively.
The subtle characteristics of this disorder make it difficult to diagnose. “Nurses play a vital role in the observation and confirmation of the profile of MSBP” (Dowdell & Foster, 2005). A diagnosis is based on the observations of the signs and symptoms, as there is no known pathophysiology. Signs and symptoms leading to the diagnosis of MSBP are not easily recognised. MSBP “frequently goes undiagnosed-the true incidence is not known” (Thomas, 2003). This is a direct result of the unfamiliarity of the syndrome as well as the failure to consider the diagnosis. A “better knowledge of the disorder and analysis of large number of homogeneously and detailed reported cases” (Szoke, 2000) is needed. Health care professionals especially nurses need to keep updated on current literature. Knowing about the possibility is the first step in achieving a diagnosis and getting help for the victim.
Diagnosis alone may take months or years. “The average length of time to the diagnosis of MSBP generally exceeds six months” (Dowdell & Foster, 2005). With time the perpetrator becomes more convincing and practised at being deceitful. This also impacts the process of detection and proving an MSBP diagnosis. Increasing the difficulty of catching the perpetrator in the act of deceit or inflicting harm.
One apparent sign of MSBP is the fact that the child is ill with the perpetrator but when separated the child’s condition improves. As noted by Huynh, the acute signs and symptoms decrease when the child is separated from the parent. Given this fact observation and documentation of such characteristics by the nurse is key. Another sign is a family history, including death of a sibling. “There is a high incidence of unexplained sibling mortality” (PhycNet-UK, 2003). In most instances the death of a sibling is what triggers the investigation to a MSBP diagnosis. The perpetrator uses the excuse that the symptoms “run in the family”. A detailed and accurate family history is important, as is communication amongst the health care team. Since deception is a characteristic of MSBP it is likely that a history taken from the perpetrator will not be accurate (Huynh, 1998). A detailed medical history from the parents in this case is rendered invalid. Discrepancies between clinical findings and the parents’ history should raise suspicion and warrants documentation. The nurse needs to pay special attention to conflicting detail and discuss concerns with the multidisciplinary team. A combined effort and high suspicion is required to make the diagnosis of MSBP.
A multidisciplinary team, that meets regularly, is important for maintaining continuity. A team consisting of nursing staff, physicians and any other professionals that are directly involved in the care of the child need to have good communication channels. Congruent care is important. MSBP is abuse and therefore matters of law are linked with the health care. The multidisciplinary team should therefore also include members from legal professions such as law enforcement and Children’s Aid Society (CAS) when the suspicion of MSBP begins. The safety of the child or children is of utmost importance.
The use of video surveillance is useful in diagnosing MSBP. A multidisciplinary team must agree that covert surveillance is needed prior to beginning the procedure in most facilities. Covert monitoring was determined to be a necessity for diagnosing MSBP over half of the studied cases by Hall et al. The use of video surveillance causes conflict with patient privacy and confidentiality (Smith-Alnimer & Papas-Kavalis, 2003). In addition Smith-Alnimer & Papas-Kavalis described how the act of abuse was not to be intervened by the nurse as to obtain evidence for legal matters. This is a direct conflict between nursing care and obtaining legal evidence to try the case. Watching someone inflict harm on a child would be difficult for anyone. The question of how much evidence is enough to take to a court of law as abuse. Is it right to let the harm be inflicted in order to have sufficient evidence for a jury? Overall the nurse often finds his or herself with ethical and legal dilemmas when dealing with MSBP. “Great distress among nurses when nurses’ sincere efforts to support and comfort the sick are exploited” (Yong & Haas, 2004) is felt. Above all the nurse must maintain a neutral status. The perpetrator has the legal right to obtain non-judgmental health care just as any other parent. Being suspected of or diagnosed with MSBP does not give the right to the nurse to treat the parent any different. As professionals, nurses must be aware of but not feed into personal biases. These persons are suffering from an illness and are deserving of compassion.
When using covert monitoring and suspecting illegal activities, the fear of litigation may be an issue for nurses. Clinical and legal standards change over time and can be difficult to be aware of. It is most important to keep focused on the patient in attempts “to provide best clinical care to guide practise, not fear of litigation” (Barloon, 2003). Sound clinical judgement is the most important characteristic to have. Barloon also states that keeping up with current literature and continuing education are crucial assets pertaining to safe and acceptable clinical psychiatric nursing practice. From a legal point of view documentation is most important. For the safety of the child a sound legal case is important. The onus is mainly on the nurse to document key findings and use sound judgement to intervene.
The perpetrator tends to have medical knowledge often from previous education and or experience in a health care field. In the study by Hall et al fifty five percent of the perpetrators had previous health care training or work and interestingly twenty five percent worked in a day care if they did not have previous health care experience. Individuals with this condition are attracted to helping professions such as nursing (Dowdell & Foster, 2005). An article written by Young and Haas describes a case in which a nursing student presented with Munchausn syndrome and the students’ daughter was a victim of MSBP. The main focus of this article was the fact that most faculties are not prepared for the possibility of encountering Munchausen syndrome in students. The knowledge of this disorder is beneficial for the detection as well as the outcome. Being a nurse in such a situation as to help a student do harm to a child is very difficult. The faculty who helped this perpetrator felt hostility after learning of the deceit and feeling exploited. Some felt guilt for teaching the perpetrator medical knowledge that potentially aided in the harm done to the child.
Treatment of this disorder typically does not have very favourable outcomes. Emphasis is put on managing rather than curing. The first step is confronting the perpetrator. Admission to the deceit may occur but more often denial is the result. The purpose is to stop the abuse and protect the child. The next step theoretically is developing a stable therapeutic relationship. With a stable relationship working, the focus of care goes to the management of the disorder including orientation to avoid unnecessary hospitalizations and medical acts (PhycNet-UK, 2003). There are no known cases of successful treatment of MSBP (Huynh, 1998). In most cases the fictitious disorders are more convincing than real cases of psychosis. The use of pharmacotherapies for MSBP is not well known. There has been some use of antipsychotic drugs with some indication of benefit (PhycNet-UK, 2003). Since “psychiatric disorders are common, in particular, personality disorders and depression” (Huynh, 1998) treatment of these disorders is the primary focus. As for psychotherapy and counselling, analytical and cognitive-behavioral approaches have been used with patients that accept and engage in treatment.
The role of the nurse in relation to MSBP is important in many ways. Close observations and documentation leads to the recognition of suspicious findings. In combination with knowledge of MSBP recognition of the signs and symptoms may lead to a diagnosis. Nurses may be the only persons to whom a mother makes statements that can be incriminating. The close professional relationship resulting from the care and ‘being there’ creates a bond between nurse and mother that no other member of the multidisciplinary team tends to develop. This trust sometimes allows for the mother to say suspicious things to the nurse. The nurse is the one who provides direct care for the child and is a fundamental member of the health care team. In a situation of caring for a child victim to MSBP the nurse must be vigilant and only intervene based on professional judgment and fact, not the demands of the parent. Support for the nurse is important. The use of a multidisciplinary team helps to support the nurse. Having others aware of the situation able to discuss details otherwise confined by confidentiality privileges is important. Nursing is a caring profession. Working with a case of suspected or diagnosed MSBP is very trying for nursing staff.
A diagnosis of MSBP is child abuse. MSBP is not a form of child abuse that is well known nor is it easily detected. Overall further research and study is needed in this area of mental health disorders. The nursing role related to the assessment, diagnosis, and treatment of MSBP is important throughout the process of detection to treatment. The most important thing is to be able to recognise and diagnose MSBP. This is accomplished firstly with increased awareness, especially nurses that care for children. With a heightened awareness nurses may be able to help the young victims from further abuse associated with MSBP. There are many ethical dilemmas and legal difficulties when gathering evidence to determine a diagnosis. The demands on nursing staff are high therefore they need strong support systems.
References
American Psychiatric Association. (2000). Quick reference to the Diagnostic Criteria from DSM-IV-TR™. American Psychiatric Association: Washington, DC.
Dowdell, E., Foster, K. (2005). Munchausen Syndrome by Proxy: Recognizing a Form of Child Abuse. Nursing Spectrum. Retrieved March 14, 2005, from http://nsweb.nursingspectrum.com/ce/ce209.htm
Barloon, L. (2003). Legal aspects of psychiatric nursing. The Nursing Clinics of North America, 38(1), 9-19.
eMedicine. (November, 2002). Factitious disorder. Retrieved March 5, 2005, from http://www.emedicine.com/med/topic3125.htm
Hall, D., Eubanks, L., Kenney, R., Johnson, S. (June, 2000). Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons From 41 Cases. Peadiatrics, 105(6), 1305-1312. Retrieved March 5, 2005, from http://pediatrics.aappublications.org/cgi/content/full/105/6/1305
Huynh, K. (December, 1998). University of Iowa physician Assistant Program: Munchausen Syndrome by Proxy. Retrieved March 5, 2005, from http://www.medicine.uiowa.edu/pa/sresrch/Huynh/Huynh/
PhycNet-UK. (July, 2003). Factitious Disorder by Proxy – Munchausen Syndrome by proxy. Retrieved March 5, 2005, from http://www.psychnet-uk.com/dsm_iv/factitious_disorder_by_proxy.htm
Schreier, H. (November 2002). Munchausen by Proxy Defined. Pediatrics, 110(5), 985-988. Retrieved March 5, 2005, from http://pediatrics.aappublications.org /cgi/content/full/110/5/985
Smith-Alnimer, M., Papas-Kavalis, H. (June, 2003). Child Abuse by a Different Name: How to recognize Munchausen syndrome by proxy. American Journal of Nursing, 103(6), 56F-56J
Szoke, A. (Otober, 2000). Facticious Disorders (Munchausen syndrome). Retrieved March 5, 2005, from http://andreisz.club.fr/index.html
Thomas, K. (2003). Munchausen syndrome by proxy: identification and diagnosis. Journal of Pediatic Nursing, 18(3), 174-180.
Turner, J., Reid, S. (2002). Munchausen’s syndrome. Lancet, 359, 346-349. Retrieved March 5, 2005, from http://www.thelancet.com/
US National Library of Medicine. (December, 2004). MedlinePlus Medical Encyclopedia: Munchausen syndrome by proxy. Retrieved March 4, 2005, from http://www.nlm.nih.gov/medlineplus/ency/article/001555.htm
Wilsey, D. (2001). Munchausen Syndrom by Proxy: The Ultimate Betrayal. American Prosecuters Research Institute Update Newsletter, 14(8). Retrieved March 5, 2005, from http://www.ndaa-apri.org/publications/newsletters /update_volume_14_number_8_2001.html
Yonge, O., Haase, M. (July/August, 2004). Munchausen Sydrome and Munchausen Syndrome by Proxy in a Student Nurse. Nurse Educator, 29(4), 166-169. Retrieved March 4, 2005, from Ovid database.
Tuesday, November 14, 2006
Monday, November 13, 2006
Women’s Health and Reproductive Hazards
Assignment Four
Industrial Relations (308)
Occupational Health and Safety
November 15, 2005
Women’s Health and Reproductive Hazards
Workplace hazards are connected to health. Julie Tisdale and Christine Sofge define reproductive hazards for women as substances or agents that affect the reproductive health, ability to become pregnant, or the future health of children. Some of theses hazards found in the workplace are well known. However there are many unknown substances that cause birth defects such as low birth weight and miscarriages. The health effects of reproductive hazards are variable often according to when the woman is exposed. There are laws and regulations that help to protect the health of women. Women need to learn their rights and learn about possible hazards in order to protect themselves.
Women’s health and reproductive hazards are not limited to just pregnancy and birth defects. This topic encompasses all aspects of women’s health as it applies to ability to become pregnant as well as the health of the fetus. Women’s health concerns include things like “hazards encountered using equipment designed for male workers of larger statures” (Tisdale & Sofge, 1998, p 651). In this case the extra strain on the woman is a health hazard. Work hazards are not simply the tangible physical aspects the psychosocial aspects are equally important. Studies have shown the stress is a major factor. Stress can affect hormones in the body and thus the reproductive system. Hormones are very important in the reproductive system. General fatigue itself could also cause difficulties in pregnancy affecting the overall health of woman and fetus.
Often the focus is on fixing the problems in the workplace after an issue arises. Health promotion in the workplace ideally should be considered equally important to understanding and managing health problems as Sara Cox, Tom Cox and Joanna Pryce stated in Work-related reproductive health: a review. With health promotion an upstream kind of approach is utilised thus eliminating risks of injury or disease. By identifying the causes of problems prior to harm and using this knowledge, prevention of injury and or disease is possible. Upstream thinking focusing on health promotion is where health professionals such as nurses would like to focus in order to prevent.
Women’s roles in the workplace have changed over the years. There has been an increase in the number of professional women. The roles in both home and workplace have various possible hazards. “Three quarters of women of reproductive age are in the workforce (Tisdale, et al, 1998, p 652).” Women work and therefore are at risk for reproductive health problems. “Although often overlooked, the workplace can have a profound impact on a worker’s health, ranging from cancer in factory workers to carpal tunnel syndrome in computer users.” (Tisdale et al, 1998, p 651) There are many health hazards in the workplace both known and many unknown.
What we can protect ourselves from right now are the known hazards. The known harmful substances are for the most part seen and therefore we are able to protect against them. We know that certain substances and viruses cause reproductive problems for example lead and rubella also known as German measles. “More than 100 years ago lead was found to cause miscarriages, stillbirths and infertility…” (NIOSH, 1999, p 3). Thus avoiding lead and viruses is important for pregnant women.
There are many unknown causes of infertility, miscarriage and birth defects. “We know that the health of an unborn child can suffer if a woman fails to eat right, smokes, or drinks alcohol during pregnancy” (National Institute for Occupational Safety and Health, 1999, p 1). The most harmful are the unknown. “The causes of most reproductive health problems are still not known. Many of these problems –infertility, miscarriage, low birth weight –are fairly common occurrences” (NIOSH, 1999, p 3). Further research is needed to ensure the reproductive safety of women in both in the workplace and in the home. For now being careful and using personal protective equipment is essential.
All health hazards are potentially dangerous to the reproductive system. Exposure to certain hazards may cause infertility or spontaneous abortion. What is known from understanding the female reproductive system? Women are born with a set number of eggs. Thus if her eggs are harmed there is no way to replace them rendering her incapable to reproduce. Once a woman becomes pregnant there are different difficulties that may arise during the pregnancy. During the first three months also known as the first trimester of pregnancy, exposure may cause a birth defect or miscarriage; this is the most likely time to have DNA altered in the unborn child. The first trimester is when the major fetal organs are formed. In the remainder of the pregnancy the organs mature and grow thus exposure in the last six months of pregnancy is more likely to affect the development of the brain and or slow the growth possibly causing premature labour. The overall health of a woman is important to maintain and promote to gain the result of healthy mothers and healthy children.
Laws and policies for equality and health have been developed. “Three basic human rights: the right to health care, non-discrimination, and reproductive self-determination” (Center for Reproductive Rights, 2005) all give the right to be healthy and survive pregnancy and childbirth. Governments are liable for the enforcement and accountability of women’s health as it applies to basic human rights. In Canada the Charter of Rights and Freedoms, 1982 outlines reproductive rights in general terms. Women need to know their rights and fight for their rights. If their employer chooses to overlook the possible hazards for the reproductive health of women point out the hazards and use the knowledge of women’s rights to rectify the problem.
Reproductive health is of utmost importance. There are multiple known and unknown health hazards and therefore the use of personal protective equipment and being safe is very important. Women need to know the basics about pregnancy and reproductive health to help protect them. Knowing that the first trimester is when the major organs are formed is important in understanding the importance of being healthy and avoiding viruses and agents that could possibly alter DNA.
The basic human right laws help to protect reproductive health however the abilities to enforce them are limited. Therefore being informed of the rights and options is important as is advocating for your rights to work in a safe environment for yourself and for unborn children. Ultimately the onus is on the individual to discuss situations with their employer to make special arrangement to ensure workplace health and safety. Reproductive health is dependant on many factors. Since many harmful substances and agents are still unknown further research is needed. Preventing reproductive health hazards is important for the overall welfare of women. The more we know about the outcomes of exposure to chemicals, viruses and other agents the better we can protect ourselves.
Bibliography
Center For Reproductive Rights. (January, 2005). Surviving Pregnancy and Childbirth: An International Human Right. Retrieved on November 17, 2005 from http://www.reproductiverights.org/pdf/pub_bp_surviving_0105.pdf
Cox, S., Cox, T., Pryce, J. (2000). Work-related reproductive health: a review. Work & stress, vol 14, no 2, pp 171-180.
National Institute for Occupational Safety and Health (NIOSH). (February, 1999). The effects of workplace hazards on female reproductive health. No. 99-104.
Tisdale, J., Sofge, C. (1998). Women and Work: Highlights of NIOSH Research. Journal of Women’s Health. Vol 7, no 6.
World Health Organization. (1999). Women and occupational health. Retrieved November 10, 2005 from http://www.who.int/occupational_health/publications/womendoh/en/
Industrial Relations (308)
Occupational Health and Safety
November 15, 2005
Women’s Health and Reproductive Hazards
Workplace hazards are connected to health. Julie Tisdale and Christine Sofge define reproductive hazards for women as substances or agents that affect the reproductive health, ability to become pregnant, or the future health of children. Some of theses hazards found in the workplace are well known. However there are many unknown substances that cause birth defects such as low birth weight and miscarriages. The health effects of reproductive hazards are variable often according to when the woman is exposed. There are laws and regulations that help to protect the health of women. Women need to learn their rights and learn about possible hazards in order to protect themselves.
Women’s health and reproductive hazards are not limited to just pregnancy and birth defects. This topic encompasses all aspects of women’s health as it applies to ability to become pregnant as well as the health of the fetus. Women’s health concerns include things like “hazards encountered using equipment designed for male workers of larger statures” (Tisdale & Sofge, 1998, p 651). In this case the extra strain on the woman is a health hazard. Work hazards are not simply the tangible physical aspects the psychosocial aspects are equally important. Studies have shown the stress is a major factor. Stress can affect hormones in the body and thus the reproductive system. Hormones are very important in the reproductive system. General fatigue itself could also cause difficulties in pregnancy affecting the overall health of woman and fetus.
Often the focus is on fixing the problems in the workplace after an issue arises. Health promotion in the workplace ideally should be considered equally important to understanding and managing health problems as Sara Cox, Tom Cox and Joanna Pryce stated in Work-related reproductive health: a review. With health promotion an upstream kind of approach is utilised thus eliminating risks of injury or disease. By identifying the causes of problems prior to harm and using this knowledge, prevention of injury and or disease is possible. Upstream thinking focusing on health promotion is where health professionals such as nurses would like to focus in order to prevent.
Women’s roles in the workplace have changed over the years. There has been an increase in the number of professional women. The roles in both home and workplace have various possible hazards. “Three quarters of women of reproductive age are in the workforce (Tisdale, et al, 1998, p 652).” Women work and therefore are at risk for reproductive health problems. “Although often overlooked, the workplace can have a profound impact on a worker’s health, ranging from cancer in factory workers to carpal tunnel syndrome in computer users.” (Tisdale et al, 1998, p 651) There are many health hazards in the workplace both known and many unknown.
What we can protect ourselves from right now are the known hazards. The known harmful substances are for the most part seen and therefore we are able to protect against them. We know that certain substances and viruses cause reproductive problems for example lead and rubella also known as German measles. “More than 100 years ago lead was found to cause miscarriages, stillbirths and infertility…” (NIOSH, 1999, p 3). Thus avoiding lead and viruses is important for pregnant women.
There are many unknown causes of infertility, miscarriage and birth defects. “We know that the health of an unborn child can suffer if a woman fails to eat right, smokes, or drinks alcohol during pregnancy” (National Institute for Occupational Safety and Health, 1999, p 1). The most harmful are the unknown. “The causes of most reproductive health problems are still not known. Many of these problems –infertility, miscarriage, low birth weight –are fairly common occurrences” (NIOSH, 1999, p 3). Further research is needed to ensure the reproductive safety of women in both in the workplace and in the home. For now being careful and using personal protective equipment is essential.
All health hazards are potentially dangerous to the reproductive system. Exposure to certain hazards may cause infertility or spontaneous abortion. What is known from understanding the female reproductive system? Women are born with a set number of eggs. Thus if her eggs are harmed there is no way to replace them rendering her incapable to reproduce. Once a woman becomes pregnant there are different difficulties that may arise during the pregnancy. During the first three months also known as the first trimester of pregnancy, exposure may cause a birth defect or miscarriage; this is the most likely time to have DNA altered in the unborn child. The first trimester is when the major fetal organs are formed. In the remainder of the pregnancy the organs mature and grow thus exposure in the last six months of pregnancy is more likely to affect the development of the brain and or slow the growth possibly causing premature labour. The overall health of a woman is important to maintain and promote to gain the result of healthy mothers and healthy children.
Laws and policies for equality and health have been developed. “Three basic human rights: the right to health care, non-discrimination, and reproductive self-determination” (Center for Reproductive Rights, 2005) all give the right to be healthy and survive pregnancy and childbirth. Governments are liable for the enforcement and accountability of women’s health as it applies to basic human rights. In Canada the Charter of Rights and Freedoms, 1982 outlines reproductive rights in general terms. Women need to know their rights and fight for their rights. If their employer chooses to overlook the possible hazards for the reproductive health of women point out the hazards and use the knowledge of women’s rights to rectify the problem.
Reproductive health is of utmost importance. There are multiple known and unknown health hazards and therefore the use of personal protective equipment and being safe is very important. Women need to know the basics about pregnancy and reproductive health to help protect them. Knowing that the first trimester is when the major organs are formed is important in understanding the importance of being healthy and avoiding viruses and agents that could possibly alter DNA.
The basic human right laws help to protect reproductive health however the abilities to enforce them are limited. Therefore being informed of the rights and options is important as is advocating for your rights to work in a safe environment for yourself and for unborn children. Ultimately the onus is on the individual to discuss situations with their employer to make special arrangement to ensure workplace health and safety. Reproductive health is dependant on many factors. Since many harmful substances and agents are still unknown further research is needed. Preventing reproductive health hazards is important for the overall welfare of women. The more we know about the outcomes of exposure to chemicals, viruses and other agents the better we can protect ourselves.
Bibliography
Center For Reproductive Rights. (January, 2005). Surviving Pregnancy and Childbirth: An International Human Right. Retrieved on November 17, 2005 from http://www.reproductiverights.org/pdf/pub_bp_surviving_0105.pdf
Cox, S., Cox, T., Pryce, J. (2000). Work-related reproductive health: a review. Work & stress, vol 14, no 2, pp 171-180.
National Institute for Occupational Safety and Health (NIOSH). (February, 1999). The effects of workplace hazards on female reproductive health. No. 99-104.
Tisdale, J., Sofge, C. (1998). Women and Work: Highlights of NIOSH Research. Journal of Women’s Health. Vol 7, no 6.
World Health Organization. (1999). Women and occupational health. Retrieved November 10, 2005 from http://www.who.int/occupational_health/publications/womendoh/en/
plagiarism
I am posting my original works written when I was completing my university degree as well as new writings. Please do not commit academic fraud. Thank you.
A Question of Compliance for Hand Hygiene
Selected Acute Illnesses
A Question of Compliance for Hand Hygiene
March 14, 2005
A Question of Compliance for Hand Hygiene
Is there a problem with compliance related to hand hygiene in acute care clinical settings? The importance of cleanliness related to good health dates back to Nightingale (Nightingale, 1969). Proper hand hygiene is the most important factor to prevent cross contamination of microorganisms and thus communicable diseases (college of Nurses of Ontario, 2004). Yet hand washing is done less than fifty percent of the time between patients as found in most studies from the past twenty years (McGuckin, 2003). Health care workers willingly admit to neglecting hand hygiene.
Nurses often neglect to use appropriate hand hygiene between patients and prior to drawing up medications as observed in various clinical settings. With the implementation of alcohol based cleansers there has been an small increase in compliance however there is a reluctance to accept alcohol based cleansers as a substitute for hand washing (Girou, 2002). There are many factors that contribute to this non-compliance. There are also many interventions appropriate to promoting compliance. With an increase in hand hygiene compliance cross transmission of microorganisms will be prevented, consequently the number of communicable diseases will be decreased.
The accepted way to effectively wash hands includes the use of warm water and soap. Start by wetting both hands then with one to three millilitres of soap and start scrubbing. Scrub both hands, wrists and under finger nails for a minimum of ten seconds preferably longer. The soap dissolves oil and breaks the germs’ connection to the skin so they can be rinsed off with the soapsuds. Rinse off the suds one hand at a time and dry with disposable towels or a hand dryer. Use a paper towel to turn off the taps as to not contaminate your clean hands. A more detailed procedure is found on the Canadian Centre for Occupational Health and Safety (CCOHS) website. With hand washing the nurse must go to a sink and stay there to complete hand hygiene. This fact proves to be the main problem with compliance as nurses have hectic work schedules that do not always have the time and readily available washing area.
Hand hygiene using alcohol based cleansers is much less time consuming. With the alcohol based cleanser there is only one step. Rub the cleanser between both hands covering all surfaces until the alcohol evaporates completely. Alcohol based cleansers are fast acting and significantly reduce the number of micro organisms (Centres for Disease Control Prevention, 2004). There is no need to remain stationary while cleansing with the alcohol-based solution therefore nurses can perform hand hygiene while on their way to their next patient. The only indication against using alcohol-based cleansers is when hands are visibly soiled. Washing with soap and water is the only way to properly clean when hands are visibly soiled.
To wash hands effectively time, knowledge, supplies and care is needed. Nurses do not always have the time and therefore alcohol-based cleansers have been made available. As a new knowledge and practise there is a reluctance to accept the alcohol-based cleansers as a substitute for hand washing. “There is a reluctance to accept handrubbing as a substitute for hand washing, even among some infection control practitioners” (Girou, 2002). A survey indicated that the lack of confidence in the alcohol based cleansers efficacy was the main concern among health care professionals. The results of a randomized clinical trial by Girou discovered that hand rubbing with an alcohol based cleanser was more effective in reducing bacterial contamination of health care workers’ hands than hand washing. This knowledge is important to convey to nurses to help increase the confidence in alcohol based cleansers.
Using either method of hand hygiene repeatedly, as nurses do, tends to irritate and cause skin dryness. With the use of alcohol-based cleansers, use of hand lotions is recommended to minimize skin irritation and dryness (Ontario Ministry of Health and Long-term care, 2004). Since hand washing tends to dry skin more than alcohol cleansers the importance of skin integrity is clear for both methods. When selecting hand lotions it is important to consider one that will not compromise glove efficacy (Wilson, 2004). With skin irritation the use of gloves will help to avoid getting bacteria into damaged areas of skin. However the use of gloves is not a substitute for hand hygiene nor is hand hygiene a substitute for the use of gloves (CCOHS, 2004). The knowledge of the importance of hand hygiene is fundamental as is healthy skin. A combination of hand washing, the use of alcohol based cleansers, the use of gloves and moisturizing lotions must be used to maintain hand hygiene in the clinical setting.
In summary hand hygiene compliance is decreased for the following contributing factors. Hand washing is time consuming, requiring the nurse to stand stationary at a sink. Hand washing also requires warm running water, soap and paper towels which are not always readily available. The knowledge deficit related to alcohol based cleanser efficacy. Skin irritation and dryness due to repeated washing and or hand rubbing with alcohol based cleansers. All of these issues have various solutions for increasing compliance of hand hygiene in the clinical setting.
The following outlines five main interventions beneficial to promoting hand hygiene compliance in the clinical setting. Address restricted time issues with emphasis on using alcohol-based products. Convenient placement of alcohol based cleanser dispensers. Include educational interventions such as newsletters, videos, and classes. Frequent reminders including but not limited to posters, signs, and patients reminding staff. Personal, peer, and non-personalized performance feedback regarding hand hygiene practice given frequently. Finally, providing suitable hand lotions within the work environment. All of these interventions have been supported with studies performed in various different clinical settings all with positive results.
Studies have shown an increase in hand hygiene compliance with the use of alcohol-based cleansers. Most importantly further research has also proven this increased compliance to be maintained with the use of alcohol-based cleansers (Beyea, 2003). The introduction of alcohol-based cleansers addressed the ‘not enough time’ issue regarding hand hygiene. Alcohol based cleansers are convenient, rapid acting and less contact time is required. Nurses do not need to stand at a sink; they can sanitize their hands and walk at the same time. In addition there is a greater reduction in bacterial contamination of hands than conventional hand washing (Girou et al, 2002). Implementation of alcohol based cleansers within the acute care clinical setting is an overall effective approach to increasing hand hygiene compliance.
Knowledge is power. By increasing and reinforcing the knowledge base an increased compliance may be obtained. A hand hygiene intervention done by the University of Geneva using “emorational” education resulted in a twenty percent increase in compliance over a period of four years (Pittet, et al, 2000). This intervention consisted of many components such as the use of a multidisciplinary team to promote hand hygiene within the facility. Providing short on-going educational sessions for staff regarding various aspects of hand hygiene such as the efficacy of alcohol-based cleansers, acceptable hand hygiene techniques, the safe removal of gloves avoiding contamination, the risks of transmission, and the costs of health care associated infections. Making the information sessions fun and interactive by involving the staff in poster development. All of these educational elements support and reinforce hand hygiene on an on going basis. With the inclusion of frequent reminders and feedback both verbal and written the compliance is reinforced further. With positive reminders nurses are encouraged by peers and patients to properly sanitize their hands. Feedback regarding noscomial infection and rates of transmission are also encouraging. Decreasing numbers of Methicillin-resistant Staphylococcus Aureus (MRSA) were reported with the intervention implemented by the University of Geneva (Pittet, et al, 2000). This positive result reinforces the importance of increased compliance.
Have hand lotions available for nurses within the clinical setting. More importantly choose an alcohol-based product that has moisturizers and emollients already. Studies have shown that skin integrity has in fact improved with the use of such alcohol-based products (Wilson, 2004). Skin irritation and dryness is counteracted with the addition of moisturizers and emollients in the alcohol based cleansers. Traditional hand washing dissolves the oils in your hands to separate the bacteria and wash them down the drain apposed to alcohol based cleansers that kill the bacteria. With the loss of the natural oils, hands tend to become irritated and the use of lotions is beneficial to maintain skin health.
Using all of the above interventions simultaneously addressing the issues of compliance is most effective. “Performance is mainly influenced by external stimuli, and can be changed by feedback, incentives, modelling, and external reinforcement” (Grol, and Grimshaw, 2003). The most effective strategy was found to be multifaceted interventions, the combination of various teaching and reinforcing techniques (Girou, et al, 2002). Implementing programs within facilities to enhance the knowledge base and stimulate nurses to sanitize their hands regularly is within reach. With implementation evaluation must follow to complete the intervention (Pittet, et al, 2000). Evaluating an intervention that is implemented helps to reaffirm and maintain sustainable outcomes.
In acute care clinical settings nurses are strained with heavy workloads. This fact complicates certain interventions such as teaching sessions that would require time. Starting a program is the biggest step, getting a multidisciplinary team motivated. From a nurses perspective most interventions would be realistic to achieve. With a focus on increased use of alcohol-based cleansers nurses can optimize their time and ensure to perform hand hygiene appropriately. Most importantly the placement of alcohol based cleansers throughout the facility. Convenient location of hand sanitizers including every bedside and at every door is crucial to increasing compliance. Posting information sheets or posters in nursing stations and other convenient locations on the floor would increase knowledge base and encourage hand hygiene. Positive feedback and reinforcement on an ongoing basis is also important.
Increased compliance of hand hygiene in acute care clinical settings is the overall preferred outcome. Thus resulting in the prevention of cross transmission of micro organisms and communicable diseases. This is theoretically and realistically possible with the use of multifaceted interventions, continuous monitoring and re-evaluations. Positive results have been achieved with the use of multifaceted on-going interventions.
References
Beyea, S. (2003). Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operated faucets. Association Of Operating Room Nurses. Aorn Journal, 77(3), 671. Retrieved November 9, 2004, from ProQuest Nursing Journals database.
Canadian Centre for Occupational Health and Safety. (November, 2004). Hand Washing: Reducing the Risk of Common Infections. Retrieved March 5, 2005, from http://www.ccohs.ca/oshanswers/diseases/washing_hands.html
Centres for Disease Control and Prevention. (October, 2004). Hand Hygiene Guidelines Fact Sheet. Retrieved March 5, 2005, from http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
College of Nurses of Ontario. (2004, June). Practice Standard: Infection Prevention and Control. Retrieved November 7, 2004, from http://www.cno.org/docs/prac/41002_infection.pdf
Girou, E., Loyeau, S., Legrand, P., Oppein, F., BrunBuisson, C. (2002, August). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomized clinical trial. BMJ, 325(362). Retrieved November 8, 2004 from http://bmj.bmjjournals.com/cgi/content/full/325/7360/362
Grol, R., Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients' care. The Lancet, 362(9391), 1225-1230. Retrieved November 8, 2004, from ProQuest Nursing Journals database.
McGuckin, M. (2003). Hand hygiene accountability. Nursing Management, 34(4), H2. Retrieved November 8, 2004, from ABI/INFORM Global database.
Nightingale, F. (1969). Notes on nursing: What it is and what it is not. New York: Dover.
Ontario Ministry of Health and long term care. (2004, October). Public Health: Hand Washing. Retrieved November 9, 2004, from http://www.health.gov.on.ca/english/public/pub/pubhealth/handwash.html
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., Perneger, T. (2000). Hand Hygiene Campaign. Lancet, 356, 1307-1312. Retrieved November 8, 2004, from http://www.hopisafe.ch/doc/8b.doc
Public Health Agency of Canada. (2003, January). Alcohol for Hand Hygiene: New Comparative Studies Add to the Evidence Base. Retrieved November 5, 2004 from http://www.phac-pc.gc.ca/publicat/ccdr-rmtc/03vol29/dr2901eb.html
Solumed, Inc. (1998, May). Chlorhexidine Gluconate: Technical Report Review of the Literature. Retrieved November 8, 2004, from http://www.solumed.net/sm.engl/gluc.html
Wilson, S. (2004). Changing Hand Hygiene Behavior; Improving Infection Protection. The Safe Angle, 6(2),1. Retrieved November 9, 2004, from http://www.hchsa.on.ca/products/newsltrs/sa_f2004.pdf
A Question of Compliance for Hand Hygiene
March 14, 2005
A Question of Compliance for Hand Hygiene
Is there a problem with compliance related to hand hygiene in acute care clinical settings? The importance of cleanliness related to good health dates back to Nightingale (Nightingale, 1969). Proper hand hygiene is the most important factor to prevent cross contamination of microorganisms and thus communicable diseases (college of Nurses of Ontario, 2004). Yet hand washing is done less than fifty percent of the time between patients as found in most studies from the past twenty years (McGuckin, 2003). Health care workers willingly admit to neglecting hand hygiene.
Nurses often neglect to use appropriate hand hygiene between patients and prior to drawing up medications as observed in various clinical settings. With the implementation of alcohol based cleansers there has been an small increase in compliance however there is a reluctance to accept alcohol based cleansers as a substitute for hand washing (Girou, 2002). There are many factors that contribute to this non-compliance. There are also many interventions appropriate to promoting compliance. With an increase in hand hygiene compliance cross transmission of microorganisms will be prevented, consequently the number of communicable diseases will be decreased.
The accepted way to effectively wash hands includes the use of warm water and soap. Start by wetting both hands then with one to three millilitres of soap and start scrubbing. Scrub both hands, wrists and under finger nails for a minimum of ten seconds preferably longer. The soap dissolves oil and breaks the germs’ connection to the skin so they can be rinsed off with the soapsuds. Rinse off the suds one hand at a time and dry with disposable towels or a hand dryer. Use a paper towel to turn off the taps as to not contaminate your clean hands. A more detailed procedure is found on the Canadian Centre for Occupational Health and Safety (CCOHS) website. With hand washing the nurse must go to a sink and stay there to complete hand hygiene. This fact proves to be the main problem with compliance as nurses have hectic work schedules that do not always have the time and readily available washing area.
Hand hygiene using alcohol based cleansers is much less time consuming. With the alcohol based cleanser there is only one step. Rub the cleanser between both hands covering all surfaces until the alcohol evaporates completely. Alcohol based cleansers are fast acting and significantly reduce the number of micro organisms (Centres for Disease Control Prevention, 2004). There is no need to remain stationary while cleansing with the alcohol-based solution therefore nurses can perform hand hygiene while on their way to their next patient. The only indication against using alcohol-based cleansers is when hands are visibly soiled. Washing with soap and water is the only way to properly clean when hands are visibly soiled.
To wash hands effectively time, knowledge, supplies and care is needed. Nurses do not always have the time and therefore alcohol-based cleansers have been made available. As a new knowledge and practise there is a reluctance to accept the alcohol-based cleansers as a substitute for hand washing. “There is a reluctance to accept handrubbing as a substitute for hand washing, even among some infection control practitioners” (Girou, 2002). A survey indicated that the lack of confidence in the alcohol based cleansers efficacy was the main concern among health care professionals. The results of a randomized clinical trial by Girou discovered that hand rubbing with an alcohol based cleanser was more effective in reducing bacterial contamination of health care workers’ hands than hand washing. This knowledge is important to convey to nurses to help increase the confidence in alcohol based cleansers.
Using either method of hand hygiene repeatedly, as nurses do, tends to irritate and cause skin dryness. With the use of alcohol-based cleansers, use of hand lotions is recommended to minimize skin irritation and dryness (Ontario Ministry of Health and Long-term care, 2004). Since hand washing tends to dry skin more than alcohol cleansers the importance of skin integrity is clear for both methods. When selecting hand lotions it is important to consider one that will not compromise glove efficacy (Wilson, 2004). With skin irritation the use of gloves will help to avoid getting bacteria into damaged areas of skin. However the use of gloves is not a substitute for hand hygiene nor is hand hygiene a substitute for the use of gloves (CCOHS, 2004). The knowledge of the importance of hand hygiene is fundamental as is healthy skin. A combination of hand washing, the use of alcohol based cleansers, the use of gloves and moisturizing lotions must be used to maintain hand hygiene in the clinical setting.
In summary hand hygiene compliance is decreased for the following contributing factors. Hand washing is time consuming, requiring the nurse to stand stationary at a sink. Hand washing also requires warm running water, soap and paper towels which are not always readily available. The knowledge deficit related to alcohol based cleanser efficacy. Skin irritation and dryness due to repeated washing and or hand rubbing with alcohol based cleansers. All of these issues have various solutions for increasing compliance of hand hygiene in the clinical setting.
The following outlines five main interventions beneficial to promoting hand hygiene compliance in the clinical setting. Address restricted time issues with emphasis on using alcohol-based products. Convenient placement of alcohol based cleanser dispensers. Include educational interventions such as newsletters, videos, and classes. Frequent reminders including but not limited to posters, signs, and patients reminding staff. Personal, peer, and non-personalized performance feedback regarding hand hygiene practice given frequently. Finally, providing suitable hand lotions within the work environment. All of these interventions have been supported with studies performed in various different clinical settings all with positive results.
Studies have shown an increase in hand hygiene compliance with the use of alcohol-based cleansers. Most importantly further research has also proven this increased compliance to be maintained with the use of alcohol-based cleansers (Beyea, 2003). The introduction of alcohol-based cleansers addressed the ‘not enough time’ issue regarding hand hygiene. Alcohol based cleansers are convenient, rapid acting and less contact time is required. Nurses do not need to stand at a sink; they can sanitize their hands and walk at the same time. In addition there is a greater reduction in bacterial contamination of hands than conventional hand washing (Girou et al, 2002). Implementation of alcohol based cleansers within the acute care clinical setting is an overall effective approach to increasing hand hygiene compliance.
Knowledge is power. By increasing and reinforcing the knowledge base an increased compliance may be obtained. A hand hygiene intervention done by the University of Geneva using “emorational” education resulted in a twenty percent increase in compliance over a period of four years (Pittet, et al, 2000). This intervention consisted of many components such as the use of a multidisciplinary team to promote hand hygiene within the facility. Providing short on-going educational sessions for staff regarding various aspects of hand hygiene such as the efficacy of alcohol-based cleansers, acceptable hand hygiene techniques, the safe removal of gloves avoiding contamination, the risks of transmission, and the costs of health care associated infections. Making the information sessions fun and interactive by involving the staff in poster development. All of these educational elements support and reinforce hand hygiene on an on going basis. With the inclusion of frequent reminders and feedback both verbal and written the compliance is reinforced further. With positive reminders nurses are encouraged by peers and patients to properly sanitize their hands. Feedback regarding noscomial infection and rates of transmission are also encouraging. Decreasing numbers of Methicillin-resistant Staphylococcus Aureus (MRSA) were reported with the intervention implemented by the University of Geneva (Pittet, et al, 2000). This positive result reinforces the importance of increased compliance.
Have hand lotions available for nurses within the clinical setting. More importantly choose an alcohol-based product that has moisturizers and emollients already. Studies have shown that skin integrity has in fact improved with the use of such alcohol-based products (Wilson, 2004). Skin irritation and dryness is counteracted with the addition of moisturizers and emollients in the alcohol based cleansers. Traditional hand washing dissolves the oils in your hands to separate the bacteria and wash them down the drain apposed to alcohol based cleansers that kill the bacteria. With the loss of the natural oils, hands tend to become irritated and the use of lotions is beneficial to maintain skin health.
Using all of the above interventions simultaneously addressing the issues of compliance is most effective. “Performance is mainly influenced by external stimuli, and can be changed by feedback, incentives, modelling, and external reinforcement” (Grol, and Grimshaw, 2003). The most effective strategy was found to be multifaceted interventions, the combination of various teaching and reinforcing techniques (Girou, et al, 2002). Implementing programs within facilities to enhance the knowledge base and stimulate nurses to sanitize their hands regularly is within reach. With implementation evaluation must follow to complete the intervention (Pittet, et al, 2000). Evaluating an intervention that is implemented helps to reaffirm and maintain sustainable outcomes.
In acute care clinical settings nurses are strained with heavy workloads. This fact complicates certain interventions such as teaching sessions that would require time. Starting a program is the biggest step, getting a multidisciplinary team motivated. From a nurses perspective most interventions would be realistic to achieve. With a focus on increased use of alcohol-based cleansers nurses can optimize their time and ensure to perform hand hygiene appropriately. Most importantly the placement of alcohol based cleansers throughout the facility. Convenient location of hand sanitizers including every bedside and at every door is crucial to increasing compliance. Posting information sheets or posters in nursing stations and other convenient locations on the floor would increase knowledge base and encourage hand hygiene. Positive feedback and reinforcement on an ongoing basis is also important.
Increased compliance of hand hygiene in acute care clinical settings is the overall preferred outcome. Thus resulting in the prevention of cross transmission of micro organisms and communicable diseases. This is theoretically and realistically possible with the use of multifaceted interventions, continuous monitoring and re-evaluations. Positive results have been achieved with the use of multifaceted on-going interventions.
References
Beyea, S. (2003). Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operated faucets. Association Of Operating Room Nurses. Aorn Journal, 77(3), 671. Retrieved November 9, 2004, from ProQuest Nursing Journals database.
Canadian Centre for Occupational Health and Safety. (November, 2004). Hand Washing: Reducing the Risk of Common Infections. Retrieved March 5, 2005, from http://www.ccohs.ca/oshanswers/diseases/washing_hands.html
Centres for Disease Control and Prevention. (October, 2004). Hand Hygiene Guidelines Fact Sheet. Retrieved March 5, 2005, from http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
College of Nurses of Ontario. (2004, June). Practice Standard: Infection Prevention and Control. Retrieved November 7, 2004, from http://www.cno.org/docs/prac/41002_infection.pdf
Girou, E., Loyeau, S., Legrand, P., Oppein, F., BrunBuisson, C. (2002, August). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomized clinical trial. BMJ, 325(362). Retrieved November 8, 2004 from http://bmj.bmjjournals.com/cgi/content/full/325/7360/362
Grol, R., Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients' care. The Lancet, 362(9391), 1225-1230. Retrieved November 8, 2004, from ProQuest Nursing Journals database.
McGuckin, M. (2003). Hand hygiene accountability. Nursing Management, 34(4), H2. Retrieved November 8, 2004, from ABI/INFORM Global database.
Nightingale, F. (1969). Notes on nursing: What it is and what it is not. New York: Dover.
Ontario Ministry of Health and long term care. (2004, October). Public Health: Hand Washing. Retrieved November 9, 2004, from http://www.health.gov.on.ca/english/public/pub/pubhealth/handwash.html
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., Perneger, T. (2000). Hand Hygiene Campaign. Lancet, 356, 1307-1312. Retrieved November 8, 2004, from http://www.hopisafe.ch/doc/8b.doc
Public Health Agency of Canada. (2003, January). Alcohol for Hand Hygiene: New Comparative Studies Add to the Evidence Base. Retrieved November 5, 2004 from http://www.phac-pc.gc.ca/publicat/ccdr-rmtc/03vol29/dr2901eb.html
Solumed, Inc. (1998, May). Chlorhexidine Gluconate: Technical Report Review of the Literature. Retrieved November 8, 2004, from http://www.solumed.net/sm.engl/gluc.html
Wilson, S. (2004). Changing Hand Hygiene Behavior; Improving Infection Protection. The Safe Angle, 6(2),1. Retrieved November 9, 2004, from http://www.hchsa.on.ca/products/newsltrs/sa_f2004.pdf
tambour door
I decided to make a tambour door for an opening in the kitchen where the milk door used to be. This house had been built in 1974 and at that time milk was still delivered thus requiring a milk door. I have insulated and filled in the exterior hole but needed to do something with the space in the kitchen.
How I made the tambour.
Since I was not staining the door the material I used did not need to be expensive. I chose to use MDF as it is easy to find and relatively inexpensive.
I made my measurements and ripped 1/4 inch strips with the table saw. I then put double sided tape onto a solid surface with the dimensions marked for assembling the tambour. I placed the strips onto the tape ensuring the door was square and even.
I used regular wood glue to fasten the fabric to the strips of MDF. I carefully painted the glue on ensuring not to use too much then placed the fabric onto the tambour and pressed it. I allowed the glue to dry for 24 hours then removed the tambour from the double sided tape. I sanded the hole thing and then rounded all of the edges.
How I made the tambour.
Since I was not staining the door the material I used did not need to be expensive. I chose to use MDF as it is easy to find and relatively inexpensive.
I made my measurements and ripped 1/4 inch strips with the table saw. I then put double sided tape onto a solid surface with the dimensions marked for assembling the tambour. I placed the strips onto the tape ensuring the door was square and even.
I used regular wood glue to fasten the fabric to the strips of MDF. I carefully painted the glue on ensuring not to use too much then placed the fabric onto the tambour and pressed it. I allowed the glue to dry for 24 hours then removed the tambour from the double sided tape. I sanded the hole thing and then rounded all of the edges.
wallpaper
Yuk! Wallpaper everywhere. This needed to be remedied immediately also. It is a messy and time consuming job but it needed to be done. All of the wallpaper on the walls in the main floor was removed within a week of obtaining ownership of the house. This was accomplished with the help of my inlaws and lots of hot water and scraping. Wall by wall the wallpaper was removed.
Some of the wallpaper came off without much fuss but other parts required some chemical help and lots of scraping.
The resulting clean walls required a lot of finishing work but are much better now.
In the end all I can say is thank go there was no wallpaper in the living room as it is the largest room at approx 13 feet by 26 feet.
Some of the wallpaper came off without much fuss but other parts required some chemical help and lots of scraping.
The resulting clean walls required a lot of finishing work but are much better now.
In the end all I can say is thank go there was no wallpaper in the living room as it is the largest room at approx 13 feet by 26 feet.
living room
We had waited a month for possesion of the house but the time had finally came when we picked up the keys from our lawyer. We owned a house. A big house. A house that had been build in 1974 and was in need of some help.
As we walked around our house thinking about how we would like to decorate and move in we noticed a bad spot in the ceiling of the living room. It looked as though someone had tried to repair a water damaged spot. It was so bad that the decision to take the ceiling out and investigate was easily made. Before moving anything in the ceiling came out. Good thing too. After the messy removal of the stucco plaster and loose insulation we discovered that a couple of the supporting 2 X 8 's were rotted. It was obvious that at some point this house had a very bad leak and the roof had been fixed but the damage had not been fixed properly. So we bought some 2 X 8 's and glued and screwed them to the damaged ones before fixing the strapping, insulating and putting up new drywall.
The living room had origianl crown molding made of plaster and we liked it so we tried our best to keep it. This proved to increase the work involved but the end product was worth it. We had to cut around the ehole perimeter of the crown molding with a recipricating saw to make a clean edge for the drywall to be fastened and then plastered. The room is roughly 13 feet by 26 feet so this was a big job. Throughout this we tried our best not to wreck the hardwood floor.
After hours of plastering and sanding we finally were able to paint. We decided on painting the walls peppertree and leaving the ceiling white and painting all of the trimm a semi gloss white.
As we walked around our house thinking about how we would like to decorate and move in we noticed a bad spot in the ceiling of the living room. It looked as though someone had tried to repair a water damaged spot. It was so bad that the decision to take the ceiling out and investigate was easily made. Before moving anything in the ceiling came out. Good thing too. After the messy removal of the stucco plaster and loose insulation we discovered that a couple of the supporting 2 X 8 's were rotted. It was obvious that at some point this house had a very bad leak and the roof had been fixed but the damage had not been fixed properly. So we bought some 2 X 8 's and glued and screwed them to the damaged ones before fixing the strapping, insulating and putting up new drywall.
The living room had origianl crown molding made of plaster and we liked it so we tried our best to keep it. This proved to increase the work involved but the end product was worth it. We had to cut around the ehole perimeter of the crown molding with a recipricating saw to make a clean edge for the drywall to be fastened and then plastered. The room is roughly 13 feet by 26 feet so this was a big job. Throughout this we tried our best not to wreck the hardwood floor.
After hours of plastering and sanding we finally were able to paint. We decided on painting the walls peppertree and leaving the ceiling white and painting all of the trimm a semi gloss white.
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